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governor_announces_telehealth_payment_parity_in_response_to_coronavirus_outbreakGovernor Announces Telehealth Payment Parity in Response to Coronavirus OutbreakLatest_NewsShared_Content/News/Membership_Memo/20200326/governor_announces_telehealth_payment_parity_in_response_to_coronavirus_outbreak<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/Telemedicine_Consult_640px.jpg" class="pull-right" alt="Telemedicine consultation" /> </div> <h5>March 26, 2020</h5> <h2>Governor Announces Telehealth Payment Parity in Response to Coronavirus Outbreak</h2> <p><strong>Updated March 26, 2020</strong>: The WSMA thanks Washington state Gov. Jay Inslee, Health Care Authority Director Sue Birch, and Insurance Commissioner Mike Kreidler for their actions to ensure fair reimbursement for services that are delivered via telemedicine. Read our <a href="javascript://[Uploaded files/Resources/COVID19/wsma_telemedicine_parity_thank_you_letter.pdf]">thank you letter</a>, delivered March 26.</p> <p>Late Wednesday night (March 25), Gov. Jay Inslee signed a proclamation providing payment parity for services delivered via telemedicine. Specifically, the governor made <a href="[@]Shared_Content/News/Press_Release/2020/Physicians_Urge_Governor_to_Allow_Telemedicine_Payment_Parity_Bill_to_Go_into_Effect_Immediately_">implementation of Senate Bill 5385</a> effective immediately, which requires state-regulated insurance carriers to reimburse telemedicine services on par with what they would reimburse for covered services delivered in person. The order specifically prohibits health carriers from:</p> <ul> <li>Reimbursing in-network providers for telemedicine claims for medical necessary covered service at a rate lower than the contracted rate that would be paid if the services had been delivered through traditional (in-person) methods.</li> <li>Denying a telemedicine claim from an in-network provider for a medically necessary covered service due to an existing provider contract term with that provider that denies reimbursement for services provided through telemedicine.</li> <li>Establishing requirements for the payment of telemedicine services that are inconsistent with the emergency orders, rules, or technical advisories to carriers issued by the Office of Insurance Commissioner.</li> </ul> <p>The OIC on Tuesday, March 24 issued an order that allows all in-network providers to use non-HIPAA compliant communication platforms to provide patient care under certain circumstances (<a href="https://www.insurance.wa.gov/sites/default/files/documents/emergency-order-20-02_3.pdf?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=">read the OIC order</a>). This aligns with a <a href="https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html">recent federal announcement</a> around HIPAA enforcement discretion during the public health emergency. The order goes on to read that "All Regulated Entities shall treat the use of audio-only telephone as telemedicine, despite contrary language in RCW 48.43.735(8)(g)." The Washington State Health Care Authority took similar steps for our state's Medicaid and state employee plans on Monday, March 24 (<a href="https://www.hca.wa.gov/health-care-services-and-supports/hca-supports-increased-telehealth-options-medicaid-clients-public">read the HCA announcement</a>).</p> <p>At the national level, Medicare has also announced payment parity for most telemedicine services (<a href="https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet">read the CMS announcement</a>). The WSMA is reaching out to our Congressional delegation urging them to require telehealth parity policies for ERISA plans that cannot be regulated by the state - including for telephone visits, which, as we've heard from a number of our members, are reimbursed poorly.</p> <p>We expect to see more movement in the days ahead on this issue - we will keep you apprised as more parity policies are announced. The WSMA thanks Gov. Inslee, the OIC, HCA, CMS and insurance carriers such as Regence, United, and Molina, which had voluntarily adopted payment parity in advance of the orders, for taking these important steps during the COVID-19 crisis.</p> <p>Be sure to visit our <a href="[@]WSMA/Resources/COVID-19_Response/Telehealth_and_Reimbursement/WSMA/Resources/COVID-19/Prepare_Your_Practice_for_COVID-19/Prepare_Your_Practice_for_COVID-19.aspx?hkey=ed7e0075-97a3-489f-b858-92a741fc58ae">COVID-19 Telehealth and Reimbursement page</a> for more resources and information, including other breaking updates.</p> </div>3/26/2020 12:00:00 AM1/1/0001 12:00:00 AM
state_response_to_covid_19_intensifies_wsma_presses_physician_concernsState Response to COVID-19 Intensifies; WSMA Presses Physician ConcernsLatest_NewsShared_Content/News/Membership_Memo/20200326/state_response_to_covid_19_intensifies_wsma_presses_physician_concerns<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response logo" /> </div> <h5>March 26, 2020</h5> <h2>State Response to COVID-19 Intensifies; WSMA Presses Physician Concerns</h2> <p>WSMA leadership and staff have been working around the clock to mobilize our advocacy in light of the worsening COVID-19 crisis. Gov. Jay Inslee's emergency order this week for Washingtonians to "<a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-25%20Coronovirus%20Stay%20Safe-Stay%20Healthy%20%28tmp%29%20%28002%29.pdf" target="_blank">stay home and stay healthy</a>" - mandating the closure of non-essential businesses and ordering Washington residents to stay at home and avoid any unnecessary travel - reflected the urgency felt at the WSMA and by many in the physician community. In a <a href="[@]WSMA/Shared_Content/News/Press_Release/2020/WSMA_Supports_Gov._Inslee_s_Stay_Home_and_Stay_Healthy_Order_in__Response_to_COVID-19.aspx">press release</a> expressing support for the order, WSMA President William K. Hirota, MD, said, "We do not currently have the capability to test and isolate those infected with the virus, so we must do all that we can to blunt the curve. … We thank the governor for taking this courageous step and we join him in urging the public to listen."</p> <p>Gov. Inslee and Washington lawmakers continue to lobby U.S. Department of Health and Human Services for more personal protective equipment, with a shipment from the national stockpile arriving last weekend. For now, DOH is prioritizing supplies using a <a href="https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/PPEPrioritization">tiering system</a> based on confirmed case management. We are pursuing several approaches, including assessing independent/rural practice needs and working with the state and municipalities on coordinating PPE donations, to help ensure more supplies can be secured and distributed to physician practices soon. It is imperative for practices and clinics throughout the state to have the resources they need to continue to operate, so that they can alleviate pressure on our state's hospitals.</p> <p>The governor’s ban on elective surgeries and procedures is now in effect. As <a href="https://www.governor.wa.gov/sites/default/files/20-24%20COVID-19%20non-urgent%20medical%20procedures%20%28tmp%29.pdf?utm_medium=email&utm_source=govdelivery" target="_blank">detailed in the proclamation</a>, Gov. Inslee's order applies to hospitals, ambulatory surgery facilities (ASC), dental, orthodontic and endodontic offices in Washington state. We want to assure members that the proclamation only applies to the entities listed in the actual proclamation. While hospital outpatient clinics are referenced, it is to distinguish them from the hospital setting. Clinics—hospital based or otherwise—are not covered by this proclamation. If a clinic operates as an ASC, they should follow the guidance and cancel/postpone elective/non-urgent procedures unless in their medical judgment a condition will be made worse. DOH has indicated it wants patients to continue to receive care in their communities, whether in person or virtually.</p> <p>Washington state has been a leader in its handling of the COVID-19 crisis - and now, the state's emergency response has a new leader. The governor has named retired Navy Vice Admiral Raquel C. Bono as <a href="https://www.governor.wa.gov/news-media/inslee-names-retired-navy-vice-admiral-raquel-c-bono-head-washington-state-covid-19">head of the Washington state COVID-19 health care response team</a>. Vice Admiral Bono will advise the governor and state agencies on actions needed to address the capacity and strain across the health care system. The WSMA has met with Vice Admiral Bono to express our concerns with PPE, testing and supplies, and will meet with her on a weekly basis as she maps out our state's collective response to the virus.</p> </div>3/26/2020 12:00:00 AM1/1/0001 12:00:00 AM
urge_lawmakers_to_support_physician_practices_during_covid_19_responseUrge Lawmakers to Support Physician Practices During COVID-19 ResponseLatest_NewsShared_Content/News/Membership_Memo/20200326/urge_lawmakers_to_support_physician_practices_during_covid_19_response<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/MembershipMemo/2020/March/Megaphone-Evergreen-645x425px.jpg" class="pull-right" /> </div> <h5>March 26, 2020</h5> <h2>Urge Lawmakers to Support Physician Practices During COVID-19 Response</h2> <p>Washington state physicians have embraced their professionalism in its highest form during the COVID-19 crisis and put the interests of those they serve above their own. We know that many of you have done so at risk of your health, the health of your family, and possibly at a great financial loss to your practice.</p> <p>The WSMA has been advocating at both the national and the state level to not only get more test and supplies into Washington state, but to ensure that physicians can keep their doors open as they experience dramatic shifts in volume and have moved to delay elective surgeries and non-emergency procedures. Lawmakers need to hear your personal stories as well.</p> <p>We encourage you to reach out to your elected officials, sharing your experience of testing and treating COVID-19 patients and the impact the virus has had on your practice by clicking the Take Action button below. Also, the WSMA is collecting data on the economic impact the virus has had on practices. Please complete our <a href="https://www.surveymonkey.com/r/CPZMLFY">short survey here</a>.</p> <p> <!--Large text button--> <a class="TextButton Button" href="https://takeaction.wsma.org/take-action-support-physician-practices-during-covid-19/">Take Action</a> </p> </div>3/26/2020 12:00:00 AM1/1/0001 12:00:00 AM
WSMA_Supports_Gov._Inslee_s_Stay_Home_and_Stay_Healthy_Order_in__Response_to_COVID-19WSMA Supports Gov. Inslee’s Stay Home and Stay Healthy Order in Response to COVID-19Latest_NewsShared_Content/News/Press_Release/2020/WSMA_Supports_Gov._Inslee_s_Stay_Home_and_Stay_Healthy_Order_in__Response_to_COVID-19<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>March 23, 2020</h5> <h2>WSMA Supports Gov. Inslee's "Stay Home and Stay Healthy" Order in Response to COVID-19</h2> <p> SEATTLE - The Washington State Medical Association, representing physicians and physician assistants across the state - many of whom are serving on the frontlines of the COVID-19 pandemic - supports Washington State Gov. Jay Inslee's action today mandating the closure of non-essential businesses and ordering Washington residents to stay at home and avoid any unnecessary travel. The policy strengthens the state's current COVID-19 emergency response by requiring all Washingtonians to "stay home and stay healthy" unless pursuing an "essential need." </p> <p> "We do not currently have the capability to test and isolate those infected with the virus, so we must do all that we can to blunt the curve," says William K. Hirota, MD, president of the association. "The data and modeling are clear and we are learning from the experience of South Korea and China, and we must act now to minimize the damage. We thank the governor for taking this courageous step and we join him in urging the public to listen." </p> <p> Given the virus' contagiousness during a protracted incubation period—and dramatic undertesting, which has crippled public health's ability to trace and contain infections—experts agree that the next few weeks and months will see a steady rise of patients presenting at ICUs and EDs with severe COVID-19 illness. The influx of COVID-19 patients threatens to overwhelm Washington state's hospitals and emergency responders, which has led to increasingly stronger pronouncements by the governor and public health leaders urging Washingtonians to stay home and help to slow the virus' transmission. </p> <p> "We recognize the once-in-a-lifetime challenge this is for everybody, health care workers and public alike," added Dr. Hirota. "There will be economic fallout for all of society, but our initial efforts should be to keep our health care system intact and capable of handling the surge to come. We also need to protect the health of our doctors, nurses, and first responders" </p> <p> Washington state also faces a severe shortage of personal protective equipment (PPE)—critical protection for emergency care and frontline health care personnel during the pandemic, and also for physician practices and clinics throughout the state, whose ability to screen and treat potential COVID-19 patients will be crucial in alleviating pressure on our state's hospitals. </p> <p> "This really is a perfect storm—we're facing a shortage of PPE, testing, ventilators in ICUs to help with respiratory illness, even health care workers, as more of our colleagues fall ill or test positive," says Nathan Schlicher, MD, JD, president-elect of the association and an emergency medicine physician with Team Health/CHI Franciscan. "It's radically impacting health care and it's severely altering the lives of our patients, who are facing major disruption in their lives. We are truly all in this together. The governor's announcement today was the right step—and we're looking forward to working with him and our public health leaders on the next steps: getting PPE out to our clinics, expansion of COVID testing, and strategies to address the social determinants of health, including the viability of the health system as a whole, just to name a few." </p> <p> </p> <p> For more information, contact: </p> <p> Cindy Sharpe<br /> 813.244.2883 (office/mobile)<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> </p> <p> Graham Short<br /> 206.956.3633 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>3/23/2020 7:51:02 PM1/1/0001 12:00:00 AM
covid_19_emergency_volunteers_neededCOVID-19 Emergency Volunteers NeededLatest_NewsShared_Content/News/Latest_News/2020/March/covid_19_emergency_volunteers_needed<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response logo" /> </div> <h5>March 20, 2020</h5> <h2>COVID-19 Emergency Volunteers Needed</h2> <!-- Content Below --> <p>As Washington takes <a href="https://medium.com/wagovernor/inslee-issues-emergency-proclamation-that-limits-large-events-to-minimize-public-health-risk-38b4d79a563d">more steps to reduce the spread of COVID-19</a>, the Washington State Department of Health will now enroll and activate emergency volunteer health practitioners in preparation for health system requests and surging. This will help the state meet emerging demands for health care workers.</p> <p>The DOH can perform this work under the authority of the Uniform Emergency Volunteer Health Practitioner Act (<a href="https://app.leg.wa.gov/RCW/default.aspx?cite=70.15">chapter 70.15</a> RCW), if an <a href="https://www.governor.wa.gov/news-media/inslee-issues-covid-19-emergency-proclamation">emergency proclamation by the governor</a> is in effect - as is the case in Washington as of Feb. 29, 2020.</p> <p>If volunteers are registered in the volunteer health practitioner system and verified to be in good standing in all states where they are licensed, they may practice in Washington without obtaining a Washington license once activated and assigned by DOH.</p> <p>In-state practitioners can become volunteers in two ways:</p> <ul> <li>Via RCW <a href="https://app.leg.wa.gov/RCW/default.aspx?cite=70.15">chapter 70.15</a> by registering and completing the Emergency Volunteer Health Practitioners Application which can be found<a href="https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/EmergencyHealthcarePractitionersVolunteerApplication.DOCX"> here</a>.</li> <li>Via registering with their local Medical Reserve Corps; more information can be found at: <a href="https://mrc.hhs.gov/">https://mrc.hhs.gov</a>.</li> </ul> <p>Out-of-state practitioners may:</p> <ul> <li>Become volunteers via RCW <a href="https://app.leg.wa.gov/RCW/default.aspx?cite=70.15">chapter 70.15</a> by registering and completing the Emergency Volunteer Health Practitioners Application which can be found <a href="https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/EmergencyHealthcarePractitionersVolunteerApplication.DOCX">here</a>.</li> <li>Out of state MDs and DOs who would like an expedited Washington license and to volunteer, may use the <a href="https://imlcc.org/">Interstate Medical License Compact</a> and become <a href="https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders/EmergencyVolunteerHealthPractitioners">registered under RCW 70.15</a>. At this time, we are limiting our request for health care practitioners to U.S. jurisdictions due to technical issues. We may expand the call to international jurisdictions in the future as needs arise.</li> </ul> <p>Applications will be screened by the DOH to ensure the potential volunteer’s health license is in good standing in each state they where they are licensed. The DOH will activate, deploy and deactivate approved volunteer health practitioners as needs are identified and requested. Please share this urgent request broadly with other organizations, national groups, stakeholders, followers, and readers.</p> <p>FAQs about RCW 70.15 are available <a href="https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders/EmergencyVolunteerHealthPractitioners">here</a><strong>. </strong>Questions can be emailed to <a href="mailto:WAserv@doh.wa.gov">WAserv@doh.wa.gov</a> or 360.236.4090.</p> </div>3/20/2020 12:00:00 AM1/1/0001 12:00:00 AM
the_wsma_state_specialty_and_county_societies_support_gov_inslees_decision_on_elective_surgeriesThe WSMA, State Specialty and County Societies Support Gov. Inslee's Decision on Elective SurgeriesLatest_NewsShared_Content/News/Press_Release/2020/the_wsma_state_specialty_and_county_societies_support_gov_inslees_decision_on_elective_surgeries<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>March 20, 2020</h5> <h2>The WSMA, State Specialty and County Societies Support Gov. Inslee's Decision on Elective Surgeries</h2> <p> SEATTLE - Washington state Governor Jay Inslee has issued a proclamation that prohibits all hospitals, ambulatory surgery facilities, dental, orthodontic and endodontic offices in Washington state from providing health care services, procedures, and surgeries that, if delayed, are not anticipated to cause harm to the patient within the next three months, with some exceptions. </p> <p> As the facts and situation around novel coronavirus SARS-CoV-2 and its associated respiratory illness, COVID-19, continue to evolve, and in step with Gov. Inslee's proclamation, the WSMA and over 20 state specialty and county medical societies have issued recommended guidance for physicians in Washington state that follows the governor's mandate. </p> <p> "This is not guidance that we issue lightly," said Bill Hirota, M.D., president of the WSMA. "The spread of COVID-19 will be determined by our collective actions now. We believe by taking these recommended precautions, physicians can make a difference in helping to preserve the limited supply of PPE critical for emergency care and frontline health care personnel responding to the pandemic, and keeping themselves, their patients, and their communities safe." </p> <p> Examples of procedures to delay include joint replacements, most cataract and lens surgeries, cosmetic procedures and other non-urgent procedures. </p> <p> The order does not apply to outpatient visits delivered in hospital-based clinics. </p> <p> Also exempt are patients with emergency/urgent needs like heart attacks, strokes or motor vehicle accidents, and surgeries that, if not performed, would worsen the patient's condition. </p> <p> WSMA is also encouraging practices to move routine care and chronic care management to telehealth. </p> <p> "As health care professionals, we all have a role to play in slowing the spread of COVID-19 and 'flattening the curve,' by following sound scientific and public health advice, helping to limit infections, and slowing the spread of the virus," Hirota said. </p> <p> <strong>Signing in support of this statement:</strong><br /> Benton Franklin County Medical Society<br /> Clark County Medical Society<br /> Grays Harbor County Medical Society<br /> Jefferson County Medical Society<br /> King County Medical Society<br /> Kitsap County Medical Society<br /> Northwest Washington Medical Society<br /> Spokane County Medical Society<br /> Thurston-Mason County Medical Society<br /> Washington Academy of Eye Physicians and Surgeons<br /> Washington Academy of Family Physicians<br /> Washington Academy of Physician Assistants<br /> Washington Chapter of the American Academy of Pediatrics<br /> Washington Chapter of the American College of Emergency Physicians<br /> Washington Chapter of the American College of Physicians<br /> Washington State Chapter of the American College of Surgeons<br /> Washington State Council of Child and Adolescent Psychiatry<br /> Washington State Medical Oncology Society<br /> Washington State Orthopaedic Association<br /> Washington State Radiological Society<br /> Washington State Society for Post Acute and Long Term Medicine<br /> Washington State Urology Society<br /> Yakima County Medical Society </p> <p> For more information, contact: </p> <p> Cindy Sharpe<br /> 813.244.2883 (office/mobile)<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> </p> <p> Graham Short<br /> 206.956.3633 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents nearly 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>3/20/2020 12:00:00 AM1/1/0001 12:00:00 AM
washington_health_benefit_exchange_reopens_enrollmentWashington Health Benefit Exchange Reopens EnrollmentLatest_NewsShared_Content/News/Latest_News/2020/March/washington_health_benefit_exchange_reopens_enrollment<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response logo" /> </div> <h5>March 20, 2020</h5> <h2>Washington Health Benefit Exchange Reopens Enrollment</h2> <p>In response to the potential spread of COVID-19, the Washington Health Benefit Exchange is offering a limited-time special enrollment period for uninsured individuals. This special enrollment period runs through April 8, giving uninsured individuals 30 days to enroll in health insurance coverage through Washington Healthplanfinder. Individuals seeking to enroll must contact the customer support center at 1.855.923.4633; TTY: 1.855.627.9604 between 7:30 a.m.–5:30 p.m. Monday-Friday and select a plan by April 8 for coverage start date beginning April 1, 2020. Patients may also select a plan through a local certified broker or navigator. Language assistance and disability accommodations are provided at no cost.</p> </div>3/20/2020 12:00:00 AM1/1/0001 12:00:00 AM
comcast_announces_comprehensive_covid_19_responseComcast Announces Comprehensive COVID-19 ResponseLatest_NewsShared_Content/News/Membership_Memo/20200318/comcast_announces_comprehensive_covid_19_response<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" /> </div> <h5>March 18, 2020</h5> <h2>Comcast Announces Comprehensive COVID-19 Response </h2> <p> Please reach out to <a href="mailto:policy@wsma.org">policy@wsma.org</a> with any questions or for guidance around this special COVID-19 telehealth update, or for questions about using telehealth as a COVID-19 response. More information and COVID-19 practice resources at <a href="[@]WSMA/Resources/COVID-19_Response/Prepare_Your_Practice_for_COVID-19/WSMA/Resources/COVID-19/Prepare_Your_Practice_for_COVID-19/Prepare_Your_Practice_for_COVID-19.aspx?hkey=ed7e0075-97a3-489f-b858-92a741fc58ae">Prepare Your Practice for COVID-19</a>. </p> <p> For physicians or providers with patients who lack or have limited internet access, Comcast's new temporary policies may help facilitate access to telehealth services. </p> <p> For 60 days beginning March 13, Comcast will offer the following: </p> <ul> <li><strong>Xfinity WiFi Free for everyone:</strong> Xfinity WiFi hotspots across the country will be available to anyone who needs them for free – including non-Xfinity Internet subscribers. For a map of Xfinity WiFi hotspots, visit <a href="https://wifi.xfinity.com/">www.xfinity.com/wifi</a>. Once at a hotspot, consumers should select the "xfinitywifi" network name in the list of available hotspots and then launch a browser.</li> <li><strong>Pausing our data plan:</strong> With so many people working and educating from home, we want our customers to access the internet without thinking about data plans. While the vast majority of our customers do not come close to using 1TB of data in a month, we are pausing our data plans for 60 days giving all customers unlimited data for no additional charge.</li> <li>Internet Essentials free to new customers: As announced yesterday, it's even easier for low-income families who live in a Comcast service area to sign up for Internet Essentials, the nation's largest and most comprehensive broadband adoption program. New customers will receive 60 days of complimentary Internet Essentials service, which is normally available to all qualified low-income households for $9.95/month. Additionally, for all new and existing Internet Essentials customers, the speed of the program's internet service was increased to 25 Mbps downstream and 3 Mbps upstream. That increase will go into effect for no additional fee and it will become the new base speed for the program going forward.</li> </ul> <p> See <a href="https://corporate.comcast.com/covid-19">this Comcast website</a> for more information. </p> </div>3/18/2020 12:00:00 AM1/1/0001 12:00:00 AM
hhs_relaxes_telehealth_hipaa_rules_allows_for_video_chatHHS Relaxes Telehealth HIPAA Rules, Allows for Video ChatLatest_NewsShared_Content/News/Membership_Memo/20200318/hhs_relaxes_telehealth_hipaa_rules_allows_for_video_chat<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response logo" /> </div> <h5>March 18, 2020</h5> <h2>HHS Relaxes Telehealth HIPAA Rules, Allows for Video Chat</h2> <p> Please reach out to <a href="mailto:policy@wsma.org">policy@wsma.org</a> with any questions or for guidance around this special COVID-19 telehealth update, or for questions about using telehealth as a COVID-19 response. More information and COVID-19 practice resources at <a href="[@]WSMA/Resources/COVID-19_Response/Prepare_Your_Practice_for_COVID-19/WSMA/Resources/COVID-19/Prepare_Your_Practice_for_COVID-19/Prepare_Your_Practice_for_COVID-19.aspx?hkey=ed7e0075-97a3-489f-b858-92a741fc58ae">Prepare Your Practice for COVID-19</a>. </p> <p> The Health and Human Services (HHS) Office for Civil Right (OCR) has announced that it is relaxing HIPAA rules for physicians and other health care providers using telehealth in response to COVID-19. This change is effective immediately. According to OCR, the agency "…will waive potential HIPAA penalties for good faith use of telehealth during the nationwide public health emergency due to COVID-19." The OCR has offered additional guidance: </p> <p> <em><strong>A covered physician or health care provider</strong> that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency <strong>can use any non-public facing remote communication product that is available to communicate with patients</strong>. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.</em> </p> <p> <em>For example, a covered physician or provider in the exercise of their professional judgement may request to examine a patient exhibiting COVID- 19 symptoms using a video chat application connecting the physician's or patient's phone or desktop computer to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a covered physician or health care provider may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation, or psychological evaluation, or other conditions. </em> </p> <p> <em><strong>Under this notice, covered physicians and providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.</strong> Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.</em> </p> <p> More information is available on this <a href="https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html">temporary policy change here</a>. </p> </div>3/18/2020 12:00:00 AM1/1/0001 12:00:00 AM
telehealth_benefits_for_medicare_beneficiaries_expandedTelehealth Benefits for Medicare Beneficiaries ExpandedLatest_NewsShared_Content/News/Membership_Memo/20200318/telehealth_benefits_for_medicare_beneficiaries_expanded<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/March/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response logo" /> </div> <h5>March 18, 2020</h5> <h2>Telehealth Benefits for Medicare Beneficiaries Expanded</h2> <p> Please reach out to <a href="mailto:policy@wsma.org">policy@wsma.org</a> with any questions or for guidance around this special COVID-19 telehealth update, or for questions about using telehealth as a COVID-19 response. More information and COVID-19 practice resources at <a href="[@]WSMA/Resources/COVID-19_Response/Prepare_Your_Practice_for_COVID-19/WSMA/Resources/COVID-19/Prepare_Your_Practice_for_COVID-19/Prepare_Your_Practice_for_COVID-19.aspx?hkey=ed7e0075-97a3-489f-b858-92a741fc58ae">Prepare Your Practice for COVID-19</a>. </p> <p> The Centers for Medicare & Medicaid Services has expanded telehealth coverage for Medicare beneficiaries and will temporarily pay clinicians to provide telehealth services beginning March 6. As COVID-19 poses greater risks to seniors, this will allow Medicare beneficiaries to manage health issues and receive a wider range of services from the comfort and safety of their homes. </p> <p> There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries: telehealth visits, virtual check-ins, and e-visits. </p> <p> Telehealth visits – Key takeaways: </p> <ul> <li>Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.</li> <li>These visits are considered the same as in-person visits and are paid at the same rate as regular in-person visits.</li> <li>Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.</li> <li>While they must generally travel to or be located in certain types of originating sites such as a physician's office, skilled nursing facility, or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any health care facility and in their home.</li> <li>The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for physicians and health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.</li> <li>To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.</li> </ul> <p>Virtual check-ins – Key takeaways:</p> <ul> <li>Virtual check-in services can only be reported when the billing practice has an established relationship with the patient. </li> <li>This is not limited to only rural settings or certain locations.</li> <li>Individual services need to be agreed to by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient agreement. </li> <li>HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.</li> <li>HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.</li> <li>Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.</li> </ul> <p> E-visits – Key takeaways: </p> <ul> <li>These services can only be reported when the billing practice has an established relationship with the patient. </li> <li>This is not limited to only rural settings. There are no geographic or location restrictions for these visits.</li> <li>Patients communicate with their doctors without going to the doctor's office by using online patient portals.</li> <li>Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. </li> <li>The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G206, as applicable.</li> <li>The Medicare coinsurance and deductible would generally apply to these services.</li> </ul> <p> More information on the new rule can be found at this <a href="https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak">CMS webpage</a> and this <a href="https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet">Medicare telemedicine fact sheet</a>. </p> </div>3/18/2020 12:00:00 AM1/1/0001 12:00:00 AM
covid_19_concerns_cloud_positive_legislative_session_for_wsmaCOVID-19 Concerns Cloud Positive Legislative Session for WSMALatest_NewsShared_Content/News/Latest_News/2020/March/covid_19_concerns_cloud_positive_legislative_session_for_wsma<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Logos/2020-Leg-Session-Social-Graphic-645x425px.jpg" class="pull-right" /> </div> <h5>March 17, 2020</h5> <h2>COVID-19 Concerns Cloud Positive Legislative Session for WSMA</h2> <p> The 2020 Washington State Legislative Session came to a close last Thursday, and while it featured passage of numerous budget and policy bills supported by the WSMA, the news from Olympia was overshadowed by the COVID-19 outbreak centered in Washington. Talk of the virus dominated legislative discussions over the final weeks of session, and lawmakers attempted to make provision for addressing the outbreak, dedicating $200 million to response in addition to funding for public health and other elements of the health care system. </p> <p> On the final day of session, the Legislature passed a supplemental budget increasing state spending by around $1 billion, bringing the two-year budget to more than $53 billion and leaving around $3.5 billion in reserves. The latter is important, as even while legislators were leaving town there was discussion of reconvening for a special session in the coming months to make additional provision for addressing the outbreak and related impact it will have on the state's residents and economy. Economists had long noted the state was overdue for a financial downturn that now seems inevitable given the ripple effect of the outbreak. </p> <p> In the short term, legislators tapped the state's "rainy day" reserve account to appropriate $175 million for emergency response efforts related to COVID-19, which will be paired with $25 million from the federal government for the same purpose. An additional $28 million was appropriated for Foundational Public Health Services. While the funding is well-intentioned, it's likely to be outstripped by what will ultimately be needed. Had the scale of the outbreak been known earlier in session, it's likely that more would have been done in terms of both budget and policy to address, but unlikely that the Legislature would have been able to conclude its work as scheduled. </p> <p> The WSMA came into the 2020 legislative session with an agenda focused on ensuring access to care by promoting budget items and policies to positively impact the financial viability of physician practices. This is even more important in hindsight, and we were successful in working to pass legislation directing insurance carriers to reimburse for telemedicine services at parity with what is paid for in-person care, and another bill generally making provision for services to be reimbursed while a provider's insurance credentialing application is pending. </p> <p> On the budget side, the headliner for WSMA was that after years of advocacy from our organization and our allies in the physician and health care provider community, funding was appropriated to increase Medicaid primary care rates. Beginning Jan. 1, 2021, a total of nearly $29 million in state and federal funds will be used to increase primary care rates in the Medicaid system by at least 15%, and for certain pediatric neonatal intensive and critical care codes the increase will be 21%. In the primary care setting the increase will be implemented along the lines of the temporary bump afforded by the Affordable Care Act in 2013-14. Ultimately, Medicaid rates need to be increased across all physician services to fully address the need to ensure access to care, but this investment is a positive first step in that direction. </p> <p> Other notable budget items include: </p> <ul> <li>$5 million to increase Medicaid reimbursement rates for certain behavioral health codes by up to 15% beginning Jan. 1, 2021.</li> <li>$34 million to resolve pending rural health center reconciliation payments that would have been due for 2014-17.</li> <li>$8.4 million to backfill lost federal grant funding for Title X family planning services.</li> <li>The creation of a Primary Care Collaborative at the Health Care Authority with representatives from the physician community and other stakeholders charged with making recommendations on what constitutes primary care and how much should be spent on those services.</li> <li>Increased investments in the state's behavioral health system, including more than $40 million for operations and staff training at Western State Hospital.</li> </ul> <p> While this was a "short" 60-day session, there was no shortage of policy wins for the house of medicine. Priority bills that the WSMA supported that were passed by the Legislature include: </p> <ul> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=5385&Initiative=false&Year=2019">Senate Bill 5385</a> to require payment parity for services delivered via telemedicine and to remove a requirement for an in-person visit to precede covered services delivered via store-and-forward.</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=1552&Initiative=false&Year=2019">House Bill 1552</a> to generally allow for services to be reimbursed by health carriers while a physician or provider's credentialing application is pending.</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=6404&Initiative=false&Year=2019">Senate Bill 6404</a> to direct a report on health carriers' prior authorization practices, shining a light on the many circumstances in which prior authorization is a perfunctory barrier to care, and informing future legislative approaches on the subject.</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=2378&Initiative=false&Year=2019">House Bill 2378</a> to modernize the physician assistant practice act, expediting the ability of PAs to be employed and work to the limit of their license, while retaining the supervisory relationship between physicians and PAs.</li> </ul> <p> Of course, advocating for bills is only half the story in Olympia. It's equally important to stave off legislation that would negatively impact access to care, increase administrative burden on physician practices, or otherwise harm the house of medicine. Unfortunately, the Legislature failed to heed the call of the physician community to exempt physician practices and health care services from the business and occupation (B&O) tax increase on service businesses adopted last year. However, <a href="https://app.leg.wa.gov/billsummary?BillNumber=6492&Year=2019&Initiative=false">Senate Bill 6492</a>, passed by lawmakers this session, did make improvements to the tax policy by creating an exemption for businesses grossing less than $1 million and lowering the rate from 1.8% to 1.75% (up from the current 1.5%). Still, this tax increase will negatively impact the physician community and access to care at a time that could not be worse. </p> <p> In other areas of policy, legislators did follow the counsel of physicians, such as in the opioid arena, where several bad bills were defeated by the WSMA and our allies. We were also successful in working with a coalition to stop "qui tam" legislation that would have constituted a massive liability expansion for physician practices and other businesses. And the WSMA successfully opposed a bill that would have allowed for a payroll tax in King County on physician practices and other businesses that would have layered on top of the B&O tax increase. </p> <p> Scope of practice is a perennial topic of discussion in Olympia and WSMA was successful in opposing several proposals that would have jeopardized patient safety. <a href="https://app.leg.wa.gov/billsummary?BillNumber=1630&Initiative=false&Year=2019">House Bill 1630</a> would have expanded scope of practice for naturopaths and while the proposal shifted over the course of session, all iterations would have led to an inappropriate prescriptive authority increase. <a href="https://app.leg.wa.gov/billsummary?BillNumber=6609&Initiative=false&Year=2019">Senate Bill 6609</a> would have created a "psychiatric pharmacist" designation, allowing some pharmacists a massive scope of practice expansion to include many services currently provided by physicians in psychiatric settings without requiring stipulated education or training to do so. </p> <p> In all, the 2020 session was one of the most successful in record for the WSMA and the house of medicine. The session was also a reminder, however, that there are more important things happening in the world than what takes place in Olympia. Future action will be necessary in the short run to address the COVID-19 outbreak. And the economic fallout for patients, businesses, and government will likely be considerable – one of our primary points of focus is always access to care for patients and that will become even more vital in the coming months. </p> <p> Finally, we extend a huge thank you to all the physician and physician assistant members who have participated in our advocacy efforts in recent months. Whether through responding to WSMA's legislative calls to action, meeting with your legislators, attending the 2020 Legislative Summit, or taking other action to engage lawmakers, your direct advocacy is appreciated and critical to our success. Please stay in touch with our government affairs team with any questions or concerns you have with what's happening in Olympia and beyond (contact Sean Graham at <a href="mailto:sean@wsma.org">sean@wsma.org</a>). </p> </div>3/17/2020 12:00:00 AM1/1/0001 12:00:00 AM
Video__5_Things_to_Know_About_CoronavirusVideo: 5 Things to Know About CoronavirusLatest_NewsShared_Content/News/Latest_News/2020/March/Video__5_Things_to_Know_About_Coronavirus<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/WSMA/NewsAndEvents/News/hirota_covid19_patientvid_image645x425.jpg" class="pull-right" /> </div> <h5>March 7, 2020</h5> <h2>Video: 5 Things to Know About Coronavirus</h2> <p> WSMA President Bill Hirota, MD, on the 5 things your doctor wants you to know about coronavirus. A public service message from Washington State Medical Association and the Washington State Hospital Association. <a href="https://wsma.org/covid19#video">Watch the video</a>. </p> <p> Find all of our COVID-19 information and resources on our dedicated <a href="[@]WSMA/Resources/COVID-19/COVID-10_Response.aspx">COVID-19 Response webpage</a>. </p> </div>3/7/2020 5:13:45 PM1/1/0001 12:00:00 AM
WSMA_Statement_on_COVID-19WSMA Statement on COVID-19Latest_NewsShared_Content/News/Press_Release/2020/WSMA_Statement_on_COVID-19<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>March 6, 2020</h5> <h2> WSMA Statement on COVID-19 </h2> <p>The physicians of Washington state want to reassure our patients as our state experiences an outbreak of coronavirus (COVID-19). As you know, physicians treat patients with illnesses, diseases, broken bones and the like every day.</p> <p>We are still learning about this new novel virus, but what we do know now is that by following the safety precautions being given by our public health leaders, you can protect yourself and your family from contracting and spreading the virus. For those that do contract the virus, the vast majority won’t require medical treatment or testing for COVID-19—for healthy younger or middle-aged individuals, symptoms will likely be mild, and self-quarantining at home, avoiding other people where possible, washing hands, etc., should be sufficient to recover and minimize further spread of the infection</p> <p>We want to emphasize that just because you're sick, you don't necessarily need to be tested; as testing becomes more widely available, we want to focus on keeping it available to those at highest risk for health complications.</p> <p>Here’s what you should know:</p> <p><strong>First</strong>, our state’s public health responders and health care community are working around the clock to contain its spread, and—with your help—we believe we can slow its transmission.</p> <p><strong>Second</strong>, for those of you who may experience symptoms that are associated with the virus, most likely you won’t need medical treatment or even need testing for COVID-19. Your symptoms will hopefully be mild and you and your family will benefit from the healthy practices you should follow for any viral infection, including:</p> <ul> <li>Washing your hands.</li> <li>Covering your mouth with a tissue when you cough then throwing the tissue away.</li> <li>If you feel sick, staying home and letting the virus run its course, using over-the-counter medicines to help relieve your symptoms.</li> <li>Frequently cleaning and disinfecting objects and surfaces around your home.</li> </ul> <p><strong>Third</strong>, the time to call your doctor is if you develop a high fever or severe symptoms such as difficulty breathing. If you do need to visit your doctor, make sure the office knows you may have COVID-19, so that they can take steps to prevent others from being exposed or infected.</p> <p><strong>Fourth</strong>, if you are experiencing flu-like symptoms, you may not need to be tested for COVID-19. The CDC is recommending testing for people at high risk for health complications, people who have been in close contact with someone diagnosed with COVID-19, or people who have recently traveled to areas with ongoing spread of the virus. While more COVID-19 testing is becoming available, capacity is still limited. Please be understanding with physicians and office staff if it’s determined COVID-19 testing isn’t right for you. Have confidence that your care team will do everything possible to give you the treatment you need to help you feel better.</p> <p><strong>Fifth</strong>, as we observe these precautions, remember that we’re all in this together. Let’s stay calm, take care of ourselves and each other, and do our best to keep our communities healthy and strong.</p> <p>If you still have questions, call the Department of Health call center at 1.800.525.0127. It’s open from 6 a.m.-10 p.m., seven days a week.</p> <p><strong>For more information, contact:</strong><br /> <br /> Graham Short<br /> WSMA Associate Director of Communications<br /> 206.956.3633  <br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a></p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents nearly 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>3/6/2020 2:48:05 PM1/1/0001 12:00:00 AM
legislative_session_week_8_highlightsLegislative Session Week 8 HighlightsLatest_NewsShared_Content/News/Latest_News/2020/March/legislative_session_week_8_highlights<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Logos/2020-Leg-Session-Social-Graphic-645x425px.jpg" class="pull-right" /> </div> <h5>March 6, 2020</h5> <h2>Legislative Session Week 8 Highlights</h2> <p>Monday, March 2 was the fiscal committee cutoff deadline for bills that have passed out of the opposite house. Each fiscal committee had late nights, holding public hearings and voting on up to 75 bills. The rest of the week, both chambers were on the floor voting on bills, with floor debates sometimes lasting until 2 a.m. Today, Friday, March 6 is the opposite house cutoff deadline; legislators have until 5 p.m. to pass bills from the opposite chamber (i.e. a bill that started in the Senate must be approved by the House and vice versa).</p> <p>Last week, both the House and Senate released their versions of the state supplemental budget. The Legislature is working to finalize the budget, which is expected to be released next week. In responding to the coronavirus outbreak, both chambers unanimously passed <a href="https://app.leg.wa.gov/billsummary?BillNumber=2965&Year=2019&Initiative=false">HB 2965</a>. This legislation appropriates $100 million from the Budget Stabilization Account and $25 million in federal funds for state agencies, local governments, and tribes to appropriately respond to the coronavirus outbreak.</p> <h3>Legislative session week eight (March 2-6): Health care highlights</h3> <p><strong>Prior authorization –</strong> <a href="https://app.leg.wa.gov/billsummary?BillNumber=6404&Initiative=false&Year=2019">SB 6404</a>, <em>WSMA supports</em></p> <p>Senate Bill 6404 would require insurance carriers to submit certain information related to prior authorization practicessuch as requests, approvals, denials, and response times to the Office of the Insurance Commissioner.The bill passed the House on March 6. The House amended the bill on the floor, so the bill will require a "concurrence" vote in the Senate to reconcile the two versions and send it to the governor for signature.</p> <p><strong>Telem<em><em></em></em></strong><em><em> ed <strong></strong></em></em><strong>icine payment parity –</strong> <a href="https://app.leg.wa.gov/billsummary?BillNumber=5385&Year=2019&Initiative=false">SB 5385</a>, <em>WSMA supports</em></p> <p>Senate Bill 5385 would generally require payment for services delivered via telemedicine to be on par with the rate paid for in-person visits. This bill passed the House 94-3 on March 5. The House amended the bill to include an emergency clause, so the bill will require a "concurrence" vote in the Senate to reconcile the two versions and send it to the governor for signature.</p> <p><strong>Health care provider credentialing</strong> – <a href="https://app.leg.wa.gov/billsummary?BillNumber=1552&Initiative=false&Year=2019">HB 1552,</a> <em>WSMA supports</em></p> <p>House Bill 1552 would generally require health carriers to retroactively reimburse for care delivered by a physician or provider during the time a credentialing application is pending. The bill is eligible to be voted on in the Senate.</p> <p><strong>Primary care Medicaid reimbursement</strong> – <a href="https://app.leg.wa.gov/billsummary?BillNumber=6676&Initiative=false&Year=2019">SB 6676,</a> <em>WSMA supports</em></p> <p>Effective Jan. 1, 2021, would raise Medicaid reimbursement rates for primary care services by at least 15%, and for certain pediatric services by at least 21%. While the bill is no longer moving, funding was provided for primary care Medicaid reimbursement rate increases in both versions of the supplemental budget. WSMA continues to advocate for this funding to be included in the final budget.</p> <h3>Other bills voted on during week eight (March 2-6)</h3> <p><strong>The Senate voted on the following bills this week that are supported by WSMA:</strong></p> <ul> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=2378&Initiative=false&Year=2019">HB 2378</a>, physician assistant practice modernization</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=2251&Initiative=false&Year=2019">HB 2251</a>, expiration date for notification of dispensing a biosimilar</li> </ul> <p><strong>The House voted on the following bills this week that are supported by WSMA:</strong></p> <ul> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=6128&Initiative=false&Year=2019">SB 6128</a>, postpartum Medicaid coverage</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=6063&Initiative=false&Year=2019">SB 6063</a>, Department of Corrections health care administration</li> <li><a href="https://app.leg.wa.gov/billsummary?BillNumber=6526&Initiative=false&Year=2019">SB 6526</a>, prescription drug donation</li> </ul> <h3>What's happening this week (March 9-13)</h3> <p>The Legislature worked over the weekend on reconciling differences between the versions of bills that have been approved by the two chambers through the "concurrence" process. Sine die, the last day of the legislative session, is scheduled for March 12. Legislators may work up until midnight that day (and often do). We will provide post-session summary materials as soon as possible after the Legislature adjourns. Look for a quick run-down this Friday, provided that sine die occurs on Thursday as scheduled.</p> </div>3/6/2020 12:00:00 AM1/1/0001 12:00:00 AM
video_legislative_session_week_8_in_briefVideo: Legislative Session Week 8 in BriefLatest_NewsShared_Content/News/Latest_News/2020/March/video_legislative_session_week_8_in_brief<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><a href="https://vimeo.com/395830942"><img alt="" src="/images/News/Sean-Week-8-Update-3-5-play-button-645x425px%20(1).jpg" class="pull-right" /></a> </div> <h5>March 6, 2020</h5> <h2>Video: Legislative Session Week 8 in Brief</h2> <p> In this week's legislative update, WSMA Director of Government Affairs Sean Graham talks about the Legislature's response to the continuing outbreak of COVID-19 in Washington, and recaps the bills we're hoping to see cross the finish line before session's scheduled end next Friday, March 12. <a href="https://vimeo.com/395830942">Watch the video</a>. </p> <p> Watch all of our 2020 session update videos on our <a href="https://vimeo.com/showcase/5835487">Vimeo page</a> </p> </div>3/6/2020 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_march_6_2020_medical_expertise_and_assessment_are_key_in_covid_19_outbreakWeekly Rounds: March 6, 2020 - Medical Expertise and Assessment Are Key in Covid-19 OutbreakLatest_NewsShared_Content/News/Weekly_Rounds/2020/weekly_rounds_march_6_2020_medical_expertise_and_assessment_are_key_in_covid_19_outbreak<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly-Rounds-Article-Graphic-645x425px.jpg" /></div> <h5>March 6, 2020</h5> <h2>Medical Expertise and Assessment Are Key in Covid-19 Outbreak</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> When my phone rang this afternoon and the caller ID said "Jay Inslee," I knew it could only be about one thing: Covid-19. </p> <p> Gov. Inslee, like all of us, is concerned about this outbreak and wants to help ensure that the right messaging is getting out to the people of Washington. He called me to offer his support of the medical community, citing the importance of medical judgment in assessing patients who need testing and those who don't. </p> <p> And now that the University of Washington did the impossible and <a href="https://drive.google.com/file/d/1viO7SUTZbFiySqj1bbJVKWaZ4oIFKIwP/view">created new diagnostic test for the virus</a>, it won't be surprising for more and more patients to ask to be tested. But as we know, while the test is becoming more available (thank you, UW!), that doesn't mean everyone needs to be tested. We want the tests to be available for those who need it most. </p> <p> According to the <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html">latest CDC guidance</a>, clinicians should use their judgment to determine if a patient has signs and symptoms compatible with Covid-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of Covid-19, as well as the clinical course of illness. Most patients with confirmed Covid-19 have <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#foot1">developed fever</a> and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza. </p> <p> Epidemiologic factors that may help guide decisions on whether to test include: any persons, including <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#foot2"> </a>, who have had <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#foot3">close contact</a> with a <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#foot4">laboratory-confirmed</a> Covid-19 patient within 14 days of symptom onset or a history of travel from <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#foot5">affected geographic areas</a> within 14 days of symptom onset. </p> <p> As always, we encourage you to talk to your patients about whether testing in appropriate based on your medical judgment. </p> <p> If you want to learn more directly from the CDC on what clinicians need to know, you may want to participate in their CDC Clinician Outreach and Communication Activity (COCA) calls. The next COCA call for clinicians is scheduled tomorrow (Thursday), March 5 from 2-3p.m. (Eastern Time). <a href="https://emergency.cdc.gov/coca/calls/2020/callinfo_030520.asp">Click here</a> to learn more about registering to access the call or watch it <a href="https://www.facebook.com/CDCClinicianOutreachAndCommunicationActivity/?deliveryName=FCP_8_DM21038">here</a> on Facebook Live. </p> <p> We are monitoring this situation closely and reporting out to our physician community as needed. But we want to hear from you. What are you seeing in your practices related to Covid-19? Are you getting inundated with calls? Do you need assistance or resources for your practice? Let us know. Email us at <a href="mailto:wsma@wsma.org">wsma@wsma.org</a> or write me directly at <a href="mailto:jen@wsma.org">jen@wsma.org</a>. In the meantime, be sure to check the latest <a href="[@]Shared_Content/News/Latest_News/2020/February20/update_and_interim_guidance_on_coronavirus_outbreak.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927&_zs=B3aFd1&_zl=XTSa6">Covid-19 news and resource roundup on our website</a>. </p> <p> Stay well everyone! </p> </div>3/6/2020 12:00:00 AM1/1/0001 12:00:00 AM
update_and_interim_guidance_on_coronavirus_outbreakUpdate and Interim Guidance on Coronavirus OutbreakLatest_NewsShared_Content/News/Latest_News/2020/February20/update_and_interim_guidance_on_coronavirus_outbreak<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Concepts/coronavirus-2020_645x425.jpg" class="pull-right" alt="coronavirus" /> </div> <h5>March 5, 2020</h5> <h2>New COVID-19 Response Resources</h2> <p>The WSMA has introduced a new dedicated webpage featuring the latest information on Washington state's response to an outbreak of the novel coronavirus COVID-19. Visit WSMA's <a href="[@]WSMA/Resources/COVID-19/COVID-10_Response.aspx">COVID-19 Response webpage</a> to find professional and patient information and resources updated daily.</p> </div>3/5/2020 12:00:00 AM1/1/0001 12:00:00 AM
a_virtuous_cycleA Virtuous CycleLatest_NewsShared_Content/News/Latest_News/2020/March/a_virtuous_cycle<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Cover-WSMA_MarApril-2020-v6-645x425px.jpg" class="pull-right" alt="WSMA Reports cover" /></div> <h5>March 4, 2020</h5> <h2>A Virtuous Cycle</h2> <p> By Nicholas Rajacich, MD </p> <p> I was surprised to hear a colleague express hesitation when I suggested that her practice, struggling with caseloads and administrative work, hire a physician assistant. After all, at my orthopedic practice, we were preparing to hire even more PAs (which will mean more than one PA per doctor). </p> <p> For our practice, it's simple: PAs help us increase access to our services (more care for more people) and help manage many of our day-to-day tasks (fewer hours spent by our physician specialists on administrative work and less-complex procedures). Put even more simply, the bottom line is that our PAs are good for our practice's bottom line - both for patient care and practice revenue. </p> <p> With most PAs trained in primary care, few come to us with experience or training in our surgical specialty. Some choose to do an additional year of specialized training, which we have found to be quite valuable. While it requires a significant commitment of time to train them both in the clinic and in the OR, the returns on this investment accrue rapidly. </p> <p> For example: In the OR, our PAs prep the patients for surgery, handle the post-op orders, apply tourniquets during the operation and, in the case of a PA who's been around a while, close and dress incisions. Complicated patient discharges? Our PAs have us covered, arranging follow-up visits, DME prescriptions, and so on. </p> <p> As their training moves along, and as the individual PA gains more experience, we give them expanded independence in our practice. With experience, we allow our PAs to see an independent panel of patients, saving the complex patients for our physicians. </p> <p> And of course, a PA can do many of the tasks that doctors are being tasked with (more and more...and more) these days. With the development of EMRs and increasing regulatory requirements, there's a large burden of administrative material that a PA can help me with. </p> <p> At this point, our investment in teaching these PAs has more than paid off. Our physicians are now freed up to practice at the highest level of our training and to see more new patients, which is a win-win for everyone. </p> <p> We do at times allow PAs to run clinics offsite. In most situations when a PA is seeing patients in clinic, there is a physician available, either by phone (with the ability to review X-rays via PACs) or in person, to answer questions or provide advice as needed. </p> <p> There are some relatively simple legal hurdles that one must address before hiring a PA, most of which can be navigated with the help of staff at the WSMA and the Washington Academy of Physician Assistants. Promising work is being done by those organizations at the state level to modernize the requirements around the PA delegation agreement - the document describing what training and supervision will be provided and what duties delegated to the PA. Ultimately, what's important is to clearly define and document the clinical partnership and to regularly revisit and revise as needed. This is key to building a successful physician-PA team and to ensure the highest quality of care for our patients. </p> <p> At our practice, the use of PAs has led to greater access to care, which, in turn, has led us to hire more PAs (I envision a day when we may well have two PAs per doctor). It's a virtuous cycle if there ever was one, and one I'll continue to recommend to other physician colleagues. </p> <p> <em>Nicholas Rajacich, MD, is a pediatric orthopedic surgeon at Mary Bridge Children's Orthopedic Clinic.</em> </p> <p> <em>This article was featured in the March/April 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>3/4/2020 12:00:00 AM1/1/0001 12:00:00 AM
partnering_to_solve_the_health_care_puzzlePartnering to Solve the Health Care PuzzleLatest_NewsShared_Content/News/Latest_News/2020/March/partnering_to_solve_the_health_care_puzzle<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Cover-WSMA_MarApril-2020-v6-645x425px.jpg" class="pull-right" alt="WSMA Reports cover" /></div> <h5>March 4, 2020</h5> <h2>Partnering to Solve the Health Care Puzzle</h2> <p> By Rita Colorito </p> <p> Residents of rural Grays Harbor County know what it means to wait for health care. The coastal southwestern Washington community has one primary care physician for every 2,980 residents, compared to the statewide ratio of one physician for every 1,220 residents, according to a 2019 analysis by the Robert Wood Johnson Foundation. Lack of access, among other factors, has taken its toll: The county ranks 36th of out 39 for overall health outcomes. </p> <p> Working in an environment that's chronically underserved requires a collaborative approach to health care, says Ken Dietrich, MD, chief medical officer for Summit Pacific Medical Center in Elma. That's where physician assistants come in. These practitioners are nationally certified and licensed to prescribe medication and practice medicine in inpatient and outpatient settings in all 50 states and the District of Columbia. </p> <h3>Improving access to care</h3> <p> To improve patient access to care, Summit takes a team-based approach, using non-physician practitioners such as physician assistants as primary care providers, or PCPs. Over the last decade, Summit has focused on recruiting PAs to fill the PCP gap. The use of these skilled and flexible practitioners, says Dr. Dietrich, is something medical centers and physician practices should consider. </p> <p> "We tell patients we have all these PCPs; does it matter who they see? Oftentimes, they say, 'I just want to get in as soon as I can,' so that's really created an opportunity for us," he says. </p> <p> Two kinds of patients need access to care, says Dr. Dietrich: those who don't have a primary care physician and those who do, but can't get in to see them. To accommodate in-paneled patients, a PA runs Summit's same-day clinic, serving as a conduit between the patient and their physician. </p> <p> "Patients can get in when they need to and the PA communicates collaboratively with that patient's physician, if necessary," says Dr. Dietrich. </p> <p> For rural communities such as Elma, PAs have proven to be an essential piece of the health care puzzle. They're also invaluable in urgent care, where reducing wait times is paramount regardless of geographic location, says Eileen Ravella, a PA-C with 36 years' experience who works in urgent care for Kaiser Permanente in Olympia. </p> <p> "The flexibility of PAs helps with patient care and throughput," says Ravella, who also serves as the president of the Washington Academy of Physician Assistants. "I'm seeing all levels of acuity I'm comfortable with. I may see a complicated patient and work with physicians to get the patient admitted, do all the evaluations, and order tests. Or I may see the lesser acuity patients and the physicians may see the extremely complicated patients to help patient flow." </p> <h3>What collaboration looks like</h3> <p> Physicians who work with PAs say they help practices see more patients and provide continuity of care. Collaboration is at the core of the PAs role in health care. </p> <p> "The collaboration looks different depending on the context, the geographic location, and the complexity of the patient," says Leah Yoke, PA-C, MCHS, who holds a joint appointment at the Seattle Cancer Care Alliance (SCCA) and Fred Hutchinson Cancer Research Center. </p> <p> Yoke, who specializes in internal medicine and infectious disease, works in inpatient and outpatient settings in concert with oncologists and hematologists to diagnose, prevent, and treat infections in patients with cancer. </p> <p> Cancer care centers also face a shortage of infectious disease physicians. Here, too, PAs can fill the gap, says Yoke, who promotes PA usage to cancer centers nationwide in her member ambassador role with the Infectious Diseases Society of America. For cancer patients, who often face a cascade of treatments and a dizzying number of specialists, PAs provide a familiar presence, says Yoke, as they are often the only provider who sees them across multiple treatments and teams. </p> <p> "Typically, we're seeing really complex patients that have multiple comorbidities," says Yoke. "Because we don't have a ton of ID physicians, I'm able to see all the patients and help teams make decisions in a timely manner and provide some of that logistical legwork that we wouldn't otherwise be able to do." </p> <p> "For the transplant service in particular, they're really a major piece of how cancer patients are cared for," says Steve Pergam, MD, MPH, an infectious disease faculty member and medical director of infection prevention at SCCA. </p> <p> "We see patients together. We review cases together. But I think they've really allowed us to see more patients in our practice," says Dr. Pergam. "Because they're consistently on service whereas as doctors we're coming on and off service all the time, they have the ability to provide additional context and continuity for patient care." </p> <h3>At the top of everyone's profession</h3> <p> PAs also allow physicians and other PCPs to work at the top of their license to focus their energies on their most complex cases. </p> <p> "In academic environments where we're often doing lots of things—research, teaching, and other responsibilities beyond just direct patient care—they are critical to our service. They communicate with teams directly and we often do a lot of shared decision-making, specifically for our complex patients," says Dr. Pergam, an associate professor in the division of allergy and infectious diseases at the University of Washington School of Medicine in Seattle. </p> <p> PAs practice in nearly every area of medicine, with approximately 50% providing primary care services. The next largest proportion, some 23%, focus on surgery or surgical subspecialties. </p> <p> "The physician assistants I've been most familiar with definitely assist the entire team in being able to be more efficient in what we do," says Jeanne Poole, MD, a professor of medicine in the division of cardiology at UWSOM. </p> <p> PAs can do a fair amount of high- level work alongside surgeons and proceduralists, says Dr. Poole. "We train them to be able to specialize and do portions of procedures, like sutures and getting access to venous systems." </p> <p> Lyle Larson, PA-C, PhD, entered the field of cardiac electrophysiology in 1986 when it was a new subspecialty at the UW Medical Center in Seattle. Along with Dr. Poole, who was a new attending physician at the time, Larson helped build the practice into what it is today. In 2018, the two also co-edited the textbook "Surgical Implantation of Cardiac Rhythm Devices." </p> <p> "It has been a positive, collaborative experience," says Larson. Because of his deep experience, Larson helps to teach electrophysiology fellows how to do the surgical aspects of pacemaker and defibrillator implantation. "When there are particularly difficult cases, the electrophysiologists expect and ask for me to be on their cases to assist them," he says. </p> <p> Dr. Poole says highly experienced PAs such as Larson are integral to the cardiac electrophysiology practice. In the operating room, a PA's experience with complicated procedures, such as carefully implanting or removing cardiac rhythm devices and leads, makes the entire procedure safer, she says. "It's also an educational opportunity for young physicians who may not have had that same degree of experience." </p> <h3>The question of oversight</h3> <p> Despite the many positives, Ravella says PAs aren't being used to their fullest potential as a result of ongoing misconceptions. </p> <p> "We're coming up against physicians who have real concerns about the perceived competition between physicians and PAs, and there is none. We can't practice without them. They are our team," says Ravella. "We're not here to replace physicians. We can't replace you. We are dependent practitioners." </p> <p> Larson echoes that sentiment: "I'm certainly qualified to do procedures on my own, but that does not make me a surgeon. That does not make me an electrophysiologist. That makes me a very, very skilled PA who can function as a right-hand man for the physicians to take care of their patients." </p> <p> Another barrier to utilization: the idea that PAs require direct supervision. In reality, PAs need minimal supervision, says Ravella. </p> <p> At Summit, physicians are available if a PA has a question or concern, but they don't have to be there physically to provide oversight, says Dr. Dietrich. "Because we have such an integrative model, on a day-to-day basis, our PCPs are touching base with one another, connecting with patients, so there's a lot of collaborative care." </p> <p> "Certainly, you don't have to have a physician right next to a physician assistant if they are working within the scope of their training," says Dr. Poole. "For procedures, that's different because you are really working as a team— multiple hands trying to accomplish a certain procedure." </p> <p> PAs can and do serve as resources for others in the medical community. Larson and Yoke both work as teaching associates at the UW Medical Center. Dr. Dietrich says experienced PAs at Summit often serve as mentors for new doctors. </p> <p> "Our PAs are highly expert, spending all of their time dealing with high- risk, immunocompromised patients," says Dr. Pergam. "Because they are so knowledgeable, they can be a great first resource for the teams to ask questions directly. And then the PA will come to us with the more complex questions." </p> <h3>Investing in the future</h3> <p> The approach to using PAs to their fullest credentialed potential needs to be well thought out, says Dr. Dietrich. Summit has a flat hierarchical structure. All team members go through initial onboarding and an external yearly peer review. This makes for a more effective, integrative, and collaborative approach to care, he says. </p> <p> Summit typically hires experienced PAs, but about three years ago, it began adding PAs directly out of training. For these PAs, Summit provides a year- long residency-style program. While there's a lot of initial oversight, as these PAs gain experience and confidence, they are given more responsibility and eventually obtain their own panel of patients to manage. </p> <p> "By investing in their training, you're investing in a resource who is hopefully going to stay with you," says Dr. Dietrich. "Can they see all complexity of patients? No. But they can see 75% of patients." </p> <p> The investment has paid off. About 25% of Summit's PCPs are PAs. If a patient develops a complex diagnosis while under a PA's care, the PA consults with physicians or other PCPs, but they would continue to manage that patient's care, says Dr. Dietrich. "It's the right care by the right person at the right time." </p> <p> It comes down to the breadth of skills PAs bring to a team, says Dr. Poole. "PAs are very well-educated individuals. Many have had some sort of prior experience, such as medic experience in the military, so their training is solid," she says. In her work, PAs have proven highly valuable members of the team. "They should be sought after and included as part of the allied professional team for anyone considering expanding their practice in that manner." </p> <p> <em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em> </p> <p> <em>This article was featured in the March/April 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>3/4/2020 12:00:00 AM1/1/0001 12:00:00 AM
training_to_address_the_regions_unmet_health_care_needsTraining to Address the Region's Unmet Health Care NeedsLatest_NewsShared_Content/News/Latest_News/2020/March/training_to_address_the_regions_unmet_health_care_needs<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Cover-WSMA_MarApril-2020-v6-645x425px.jpg" class="pull-right" alt="WSMA Reports cover" /></div> <h5>March 4, 2020</h5> <h2>Training to Address the Region's Unmet Health Care Needs</h2> <p> By Pat Curry </p> <p> In 1968, 14 former medics or corpsmen enrolled in a new program jointly sponsored by the WSMA and the University of Washington School of Medicine and funded by the National Center for Health Services Research. The 18-month program, called the MEDEX Demonstration Project, would allow them to continue the training they had gained in the military and use it to begin careers in civilian health care as physician assistants. </p> <p> The program, only the second of its kind in the nation, was created by Richard A. Smith, MD, to address a shortage of qualified medical professionals. By the time MEDEX Northwest celebrated the 50th anniversary of that first graduating class in 2019, the program had graduated more than 2,600 physician assistants. </p> <p> Over the years, the program expanded beyond accepting former military medics—it now accepts applicants with health care experience, including nurses, EMTs, Alaska community health aides, medical assistants, and athletic trainers. The original class of 14 is now 140 students training in four locations in Seattle, Spokane, Tacoma, and Anchorage, with a fifth location in Hawaii in the works. </p> <p> Central to the mission at MEDEX Northwest is a commitment to educating "experienced health personnel from diverse backgrounds to practice medicine with physician supervision." </p> <p> "As one of the original programs in the country, our program was established on people with prior health care experience," says Terry Scott, PA-C, MPA, DFAAPA, program director of MEDEX Northwest. "We still think that matters. When you walk into medicine after just two years of study, you need some experience with the health care field." </p> <p> A graduate of MEDEX, Scott trained and worked in both rural and urban communities in Washington, worked in HIV vaccine research, and provided primary care to HIV-positive patients. He joined the MEDEX faculty in 1996 and maintains a practice at the University of Washington Family Practice Residency in Seattle. </p> <p> The PA program also has gotten longer; it is now a master's degree with 27 months of training and a capstone project. The first year consists of didactic training, followed by a four- month family practice preceptorship and then six one-month clerkships in behavioral medicine, emergency medicine, surgery, inpatient, and underserved populations; and one elective. During that time, the students also work on an in-depth, clinically relevant capstone project. </p> <p> "There's been a maturing of the profession," Scott says. "The complexity of the profession requires the education be extensive and exhaustive." </p> <h3>Keeping the vision alive and moving forward</h3> <p> Senior Medical Director Tim Evans, MD, PhD, FACP, is one of the MEDEX faculty the students see in the classroom in their first year of training. Dr. Evans gives 250-300 hours of lectures a year; he says he has immense admiration for their commitment to medicine. </p> <p> "Our students, year after year after year, are really terrific," Dr. Evans says. "They're smart, they're hardworking, they're here for a reason. ... They're making some very serious sacrifices. You have to honor that, and I do." </p> <p> With the MEDEX program residing in UW's department of family medicine, the training PAs receive complements that of physicians in the same way PAs complement physicians in clinical practice. </p> <p> "Medicine is a team sport," Scott says. "You need to teach everyone how to get the highest level from their training. We want all of us out there making a difference in the lives of our patients, delivering care to the public." </p> <p> While much has changed over the last half century, Scott notes that one thing has stayed the same: the program remains committed to diversity and inclusion, equity and justice. </p> <p> "We want to provide training and education to meet the nation's health care needs," he says. "That's from Dr. Richard Smith. He had an idea of what he wanted this program to be; those values have remained. It's in our DNA. We are the current caretakers of that vision." </p> <p> The message Scott would share with WSMA members is that MEDEX is a well-established program and that PAs are not technicians. </p> <p> "We are health care providers trained to deliver high-quality health care in collaboration with physicians," he says. "What doesn't change is a team- based approach to medicine. We are still here determined to deliver high-quality health to the region and the country." </p> <h3>A mission of rural service</h3> <p> Heritage University, Washington state's second PA training program, currently is training its fifth class of PAs. Program Director Linda Dale, PA-C, DHEd, has been a PA since 1996 and taught for 10 years at MEDEX. </p> <p> The mission of Heritage University's program is to put its students in primary care in rural, underserved areas. </p> <p> "We are in Toppenish," she says. "We're in the middle of the hop fields; we are a Hispanic-serving institution. I was born and raised in this area; it's always been medically underserved. Most Washington counties are. Even in King County and Spokane County, there are pockets that are underserved. Our mission is to increase access to health care for those populations." </p> <p> "That's an intense need," says Medical Director Joseph DiMeo, DO. "I'm also a clinician in town. The deficits in patient access to care are acute." </p> <p> The school has "done pretty well so far" in addressing that mission, Dale says. The national average for PAs working in rural areas is 12.5%; Heritage has 24% of its grads working in rural areas, she says. Nationally, 26.7% of PAs work in primary care; for Heritage grads, it's 46%. </p> <p> The focus of Heritage University's training is primary care. It complements the training of physician students by following the medical model for training. On a weekly basis, students attend class with DO students at Pacific Northwest University. </p> <p> "We are side-by-side with DO students doing case discussions and workshops where they'll do sutures, splinting, casting," she says. "It's an interprofessional education, not only with DO students but nursing, pharmD, and paramedic students, for some of our clinical case discussions." </p> <p> Heritage teaches in systems modules, such as the cardiovascular system. A module covers anatomy and physiology, how to do an exam, what it looks like in a child, an adult, an elderly patient, chronic conditions and how that presents in the ER, Dale says. </p> <p> "In that same model, we'll teach how to treat it, including pharmacology and lifestyle," she says. "When complete, we test on it. Once that's tested, we moved to the next system." </p> <p> The biggest difference from MEDEX's curriculum comes in the clinical year, Dale says. Heritage places students in a clinical site for a full year, working there two days a week. For the rest of the week, they do their specialties—surgery, pediatrics, obstetrics and gynecology, inpatient, emergency medicine, and mental health—switching about every six weeks. Sites are primarily in Washington, Idaho, Montana, and Alaska. </p> <p> "The beauty of that is that when they learn something in their specialty, they'll bring it back to primary care," she says. "It gives them a great handle on it and takes the fear away from having to know everything as a primary care provider. I think that is why we have 46% of our students in primary care; they've been in it for a full year. </p> <p> "This training is what a family practice physician used to do in the old days," she says. "Now with changes in their training, we're seeing more and more physicians go to specialties. We're trying to go back to the family medicine model. Sometimes, the old ways might be better." </p> <p> That focus is being coupled with more and more simulation, Dr. DiMeo says. The result is that students get a greater experience of hands-on integration with medical decision-making "so they can handle more difficult things in a safe environment before they go into clinical practice." </p> <h3>Evidence of impact</h3> <p> Even with just four graduating classes under its belt, Heritage University already is seeing its efforts rewarded with increased access to health care in underserved areas. </p> <p> "The impact on those patients' lives is difficult to measure, but relieving the pressure on the other clinicians in the area cuts down on their stress and ultimately keeps them practicing in those areas longer," she says. </p> <p> To help address the workforce challenges physicians are facing, Heritage University works to get students ready to see patients as soon as they finish their clinical rotation, Dr. DiMeo says. "They're not a draw against the number of patients the [physician] has to see in a day." </p> <p> "Over the course of their training and then when they go into clinical practice, their education needs to continue," he says. "They need to fit into the practice; there needs to be a comfort level between what the PA thinks they can handle and what the physician thinks they can handle, communicating on a daily basis about any complicated things. That's less and less over time. ... Even at times a physician will be challenged and call for a consult. That is the way medicine is practiced." </p> <p> <em>Pat Curry is senior editor of WSMA Reports. </em> </p> <p> <em>This article was featured in the March/April 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>3/4/2020 12:00:00 AM1/1/0001 12:00:00 AM
 

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